An apical symphysial technique using a wide absorbable mesh placed on the apex for primary spontaneous pneumothorax

Abstract

Placement of a wide absorbable mesh with fibrin glue at the apical visceral pleura significantly reduced postoperative recurrence after thoracoscopic bullectomy for PSP. The mesh was thought to act as a foreign body on the pleura and induce local inflammatory adhesion between the apical pleurae after bullectomy. This was an easy and effective symphysial procedure.

Staple Line Coverage with a Polyglycolic Acid Patch and Fibrin Glue without Pleural Abrasion after Thoracoscopic Bullectomy for Primary Spontaneous Pneumothorax

“…Staple line coverage with an absorbable patch has been reported to be an effective method for reducing the postoperative recurrence rate after thoracoscopic stapled bullectomy [ 12 – 16 ]. The high recurrence rate after thoracoscopic stapled bullectomy has been attributed to causal factors such as collapsed emphysematous bullae during unilateral ventilation and the insufficient observation of rarely diseased areas, inappropriate visualization of the diseased areas on the mediastinal side, and new bulla formation near the staple lines [ 13 , 15 , 20 ]. In contrast, postoperative air leakage occurs mainly along the staple lines, as a result of stapling difficulties, incomplete bullae resection, emphysematous changes in the resected area, or staple line crossing [ 21 ].…”

Association between postoperative bulla neogenesis at the staple line and resected lung weight for primary spontaneous pneumothorax: a retrospective study using the inverse-probability of treatment weighted method in patients grouped according to age

“…In a study by Lee et al, it was shown that the use of fibrin glue and absorbable cellulose mesh for re-enforcement of the staple line after VATS bullectomy was comparable to mechanical pleurodesis in terms of prevention of postoperative PSP recurrence (4). Another study by Nakanishi revealed that the combined use of fibrin glue and an absorbable sheet in stapled VATS bullectomy reduced the 5-year recurrence rate of postoperative PSP (5). However, the intraoperative use of fibrin glue has the potential risk of exposure to infectious agents (8).…”

“…In a modification of the original surgical technique, the staple line is reinforced with an absorbable sheet and/or fibrin glue to prevent POBN. Several reports have demonstrated the utility of this reinforcement technique in reducing the postoperative PSP recurrence rate (4,5,7). However, the use of fibrin glue involves the risk of exposure to infectious agents (8).…”

“…Thus, the reduction of post-therapy recurrence rate is of particular importance. For surgical treatment of PSP, bullectomy, using autosutures under video-assisted thoracoscopic surgery (VATS), is the standard procedure at present (1)(2)(3)(4)(5)(6).…”

A New Method to Detect Air Leakage in a Patient With Pneumothorax Using Saline Solution and Multidetector-Row Spiral CT Scan

“…These shadows were believed to refl ect air leakage through the narrow pore of the lung. The bulla blowing out air should be considered to exit in or near the shadows ( Figs 1B2, 2A, 3 ).…”